Context Note
This document is a brochure for patients who have just had cardiac surgery. The brochure is for people who have had
open heart surgery, a minimally invasive procedure, or pacemaker implantation. The intended audience is post-op cardiac
surgery patients and the brochure would be available on the inpatient floor they stay on. I made this particular brochure with
Beth Israel Deaconess Medical Center in mind because that is where I worked. I put in fake doctor’s names and phone
numbers for the purposes of this assignment.
While the patients always want to leave as soon as possible, they also want to know everything about taking care of
themselves and maintaining their health. There is too much information, however, to teach in such a short time. Some patients
go into the surgery not knowing anything about it and all the patients are overloaded with paperwork upon discharge. The care
that they themselves need to maintain is not in one convenient spot, but on numerous sheets of paper. The first couple of days
after surgery, the patients are concentrating on improving physically and moving their bowels. This usually overtakes their
interest in the aftercare so a lot of people go home not completely understanding the information. This brochure includes all if
the information that I found myself repeating to the patients daily. Many patients end up back in the hospital with an infection.
This brochure will give them a very basic, simplified information sheet that they can also hang on their fridge or somewhere in
their house as a reminder every day.
Response Letter
I would like to thank the three people who reviewed this brochure before I made the final copy. I really appreciated
their comments and agreed with most of them, making the necessary changes. Reviewer #1 felt that the rough draft of this
brochure needed some more pictures; there was too much wordiness. I agreed with this on the second page, but I felt the first
page was well-designed. I added two pictures to supplement the information on that page and made sure that the text was
broken up by different boxes and charts. This reviewer also thought that the reader would benefit from a more shaded
background other than white. Because of this, I changed the white background to a light gray.
Reviewer #2 noted a couple different issues with the wording of this brochure. The first one was that the reader might
not know exactly what “hypoglycemia” means and the units of blood sugar measurements are. When reviewing the brochure, I
made sure to put in the units of measurement and what hypoglycemia is. Another critique that was made is that the sentence
“You weight more than 10 pounds” did not speak to the audience’s level of intelligence. I agree that it sounded like I was
talking down to the audience. Because of this, I decided to not put in in capital letters and changed the wording a bit. It does
still tell the audience something that they already know, but it is something that they do not think of. In my practice, I found
when I told the patient this fact; it was like a light bulb went on in their mind. They understood much more the importance of
not using their arms to push which is why I wanted to keep this statement in the brochure, as a daily reminder.
Reviewer #3 gave a friendly reminder to make the brochure reach 1000 words which I made sure to do throughout the
editing process. Overall, the reviewers were very helpful with their critiques and I took these ideas into consideration when
editing the brochure.
HAVE YOU HAD
CARDIAC SURGERY?
DO YOU KNOW WHAT TO DO NOW?
CABG-Coronary Artery Bypass Graft
MVR-Mitral Valve Replacement
AVR-Aortic Valve Replacement
TVR-Tricuspid Valve Replacement
Aortic Aneurysm Repair
WHEN TO CALL THE SURGEON
 Temperature greater than 100.5°
 Discharge from your chest incision
– small spots of blood is normal in
the beginning
 Gain of 2 pounds in one day or 5
pounds in one week
 Sternal click – a clicking sound
heard in your chest with deep
breaths or certain movements
An elevated temperature or discharge
from the chest incision could indicate a
possible infection. If you had a CABG, it is
normal for the leg incision to have some
discharge, but not the chest incision.
Weight gain is an indication of retaining
fluid which makes the heart work much
harder than it normally has to.
A sternal click is a sign that the sternum
is unstable and the wires may have come
apart. If you have a mechanical valve,
clicking is normal; you will know the
difference between a sternal click and a
valve click.
YOUR HEART IS
REPAIRED…NOW WHAT?
IN THIS BROCHURE, YOU WILL
FIND DISCHARGE INSTRUCTIONS
AND HOW TO TAKE CARE OF
YOURSELF AT HOME OR REHAB,
INCLUDING DAILY ACTIVITIES!
STERNUM CARE










Shower daily, washing your chest
incision with soap and water.
Use a plain, white soap without
lotions, moisturizers, or scents
such as Dove, Dial, or Ivory.
Scrub small circles lightly from top
to bottom.
DO NOT use any sprays
(perfumes/cologne), creams, or
ointments. These WILL cause an
infection. Deodorant is safe.
DO NOT take baths or swim until
the incision is completely healed.
Sitting in warm water will cause
infection.
Dermabond-liquid bandage on
incision will fall off naturally in 7-10
days. Do not pull any pieces off.
Leg incision steri-strips will also
fall off naturally.
Monitor Vital Signs!
Temperature: 97.0° - 100.5°
Heart Rate: 60 bpm – 100 bpm
Blood Pressure: 100/50 – 140/80
These ranges apply to the majority
of people, but may vary, so ask
your doctor what your baseline is.
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
Main Phone | (617) 667-7000
Surgeons’ Phone Numbers
Doctor Smith (617) 555-5555
Doctor Martin (617) 567-7436
Doctor Williams (617) 723-4598
Know your baseline and keep track of all
measurements.
ACTIVITY
WHAT ELSE SHOULD I DO?
STERNAL PRECAUTIONS

Wearing a bra: women should wear the
surgi-bra for 23 out of 24 hours in a day for
one month. Take it off twice a day for 30
minutes each to let the skin breath. Always
sit with it off. DO NOT lie down or stand
up, because breasts pull on the incision.
 Lifting Restrictions: NO MORE THAN 10
POUNDS FOR
10 WEEKS! 10 poundsCAPTION
equals
CAPTION
about one gallon of milk.
CAPTION
CAPTION
 Sitting/Standing up: Roll onto side, swing
legs over the edge of the bed, and use your
elbow to slightly push your body to a
sitting position. DO NOT push or pull your
body up. If you push yourself up, you are
pushing more than 10 pounds!
 Driving: Do not drive for a month (longer if
you take narcotics past one month) and sit
in the back seat for a month. An airbag
would break the sternum.
Blood Sugars (BS)




Important to monitor
your blood sugar regularly if you are diabetic.
High blood sugar increases your
chance of getting an infection and poor
wound healing.
Acceptable Range: 80-120 mg/dL
Hypoglycemia (low BS) Symptoms:
Hungry/Nauseous, Nervous, Confused,
Blurred Vision, Fainting
Home or Rehab? As much as you want to go home, it may not be the best option for your recovery.
Rehab is an option if you are not physically progressing as much as you should be. Cardiac rehab is not
permanent and can range in length from a couple of days to about two weeks. It will consist of physical
therapy and assistance with daily activities until you are able to perform as you did before surgery.
Bleeding Precautions with
Anticoagulants
DAILY ACTIVITIES TO REMEMBER!
 Take your temperature and weigh yourself

at the same time
every day, monitoring

for any changes.
 Take small, frequent
walks every day. As tolerance progresses, 
you may take longer, less frequent walks. 
 Set a goal each day, starting with three or
four walks, and progressing gradually each
day until you are able to walk as you did
before the procedure.
 Use a chart like this to help you keep track!
Daily Task
Temp.
Weigh
Walk 1
Walk 2
Walk 3
Walk 4
S
M
T
W
Th
F
Sa
Use an electric razor – not a
straight edge razor.
Be very careful when cutting your
nails or flossing.
Use a soft-bristled toothbrush.
Avoid blowing your nose forcefully
or straining during a bowel
movement.
PACEMAKER/MINIMALLY INVASIVE
PROCEDURE




Avoid lifting the affected side’s arm
above the head for at least 2 weeks.
You do not have to adhere to
sternal precautions!
Wear a medic alert bracelet to alert
people that you have a pacemaker.
Avoid MRIs and request a hand
search at the airport. Do not go
through the metal detector or use a
handheld search device.
Avoid driving for 2 weeks.
Report any beeping from the
device.
 Use a chart and pill case to remember to

take all of your medications at the correct

times.
 Do not have sex until you are able to climb
YOU ARE NOW READY TO
two flights of stairs without getting short of
SAFELY LEAVE THE HOSPITAL!
breath.
**Note: A family member or friend should pick you up from the hospital. We recommend having someone stay with you for at least a week to help keep
track of your medications and to assist you with daily activities. It is always good to have someone close in case of an emergency or even if you are just
uncertain of something. If you are ever unsure of whether or not you should call the surgeon, it is good to call and he can determine if you should come in.
References
Balancing Beauty & Bedlam. (February 4, 2014). [Weight on scale]. Retrieved from http://beautyandbedlam.com/
category/family/balancing-family-life/fitness/.
Componenet 1. [Blood sugar monitor]. Retrieved from http://sites.bergen.org/istf/10-2309/component%201%20pge.html.
Doc Stoc. (2011). [Physical measurements vital signs]. Retrieved from http://www.docstoc.com/docs/100297296/Physical
Measurements-Vital-Signs-Height-Weight.
Science Kids. (2014). [Diagram of human heart]. Retrieved from http://www.sciencekids.co.nz/pictures/humanbody/
heartdiagram.html.